|
Cancer Society Publications Report Almost Half Of All Cancer Deaths
Have Modifiable Risk Factors That Aren’t Being Modified Sufficiently
According to a new report from the American Cancer Society (ACS)
entitled “Prevention and Early Detection Facts and Figures” and an
accompanying review article in Cancer Epidemiology, Biomarkers, and
Prevention by Ann Goding Sauer and colleagues at the ACS,
approximately 45% of
the estimated 607,000 cancer deaths expected to occur in the U.S. in
2019 are associated with potentially modifiable risk factors such as
cigarette
smoking,
excess body weight, alcohol intake, physical inactivity, and unhealthy
diet.
Cigarette smoking alone accounts for approximately 29% of all cancer
deaths, and the ACS report discusses in detail how this principal
cause of cancer can be attacked more effectively. However, at present
many proven strategies to reduce cancer risk of all types are not
being applied optimally, especially among the populations at high
risk.
The new
biennial report of the American Cancer Society is organized by
different chapters focused on a different category of risk factor or
intervention and provides an informative discussion of effective
strategies that can be implemented. Reading the report provides a
glimpse of the state of cancer control in the US.
Selected
highlights from the report and review article for each major category
of risk factor are presented below, including a table showing the
percentage of all cancers accounted for by the risk factor. The table
is adapted from the report.
|
Risk Factor |
%
of all Cancer Deaths |
|
Tobacco |
29 |
|
Excess Weight |
5 |
|
Alcohol |
4 |
|
Diet |
5 |
|
Inactivity |
2 |
|
UV
Radiation |
1.5 |
Tobacco
In 2017,
more than 34 million adults or 14.1% were current smokers. Despite
significant overall declines, smoking prevalence remains substantially
higher among some populations. For example, while only 5.0% of female
college graduates smoke, 30.1% of men with less than a high school
education were smokers, a six-fold difference. Among both men and
women, smoking prevalence was lowest among Asians (10.6% and 3.6%,
respectively) and highest among American Indian/Alaska Natives (27.3%
and 21.5%, respectively). Possible interventions that could be used
more effectively include regulation, taxes, cessation assistance, age
restrictions, and countering tobacco marketing.
Excess body weight
Excess
body weight is defined as being overweight or obese; in 2015-2016,
approximately 7 in 10 adults had excess body weight. While the
prevalence of overweight has remained relatively stable among adults
since the early 1960s, obesity has increased markedly. In 1960-1962,
10.7% of men and 15.8% of women were obese; in 2015-2016, these
proportions were 37.9% and 41.1%, respectively, representing about
93.3 million adults. Over half of black (54.9%) and Hispanic (50.6%)
women were classified as obese compared with 38.0% of white women.
Alcohol
In 2014,
about 4% of all cancer deaths in the U.S. could be attributed to
alcohol consumption. In 2017, an estimated 5.3% of adults were
classified as heavier drinkers (>14 drinks per week for men; >7
drinks/week for women) with similar prevalence by gender. Heavier
alcohol consumption increased with higher levels of education among
women (2.6% of those with less than a high school diploma vs. 7.3% of
college graduates); among men there was little variation by education.
Among both men and women, the proportion of heavier drinking was
higher among whites (men: 5.9%, women: 7.0%) than other
race/ethnicities.
Diet
About 5%
of cancer deaths in 2014 were attributed to poor diet. Overall, most
Americans do not meet the guidelines for healthy eating. In 2017, only
about 16% of adults reported consuming three or more servings of
vegetables per day. About 1 in 3 adults reported eating two or more
servings of fruit daily. Vegetable consumption was substantially lower
among Hispanics and blacks relative to whites, Asians, and American
Indian/Alaska Natives; fruit consumption was less variable.
Physical activity
An
estimated 2% of cancer deaths can be attributed to physical
inactivity. More than 1 in 4 U.S. adults (26.2%) reported no
leisure-time physical activity, with a marked disparity along
educational lines: nearly half (48.7%) of people with less than a high
school education reported no leisure time activities compared with
14.4% of college graduates.
Ultraviolet Radiation
An
estimated 1.5% of cancer deaths can be attributed to UV radiation from
the sun and indoor tanning. In 2015, more than 1 in 3 adults (35.4%)
reported at least one sunburn in the previous year. Among adults,
indoor tanning in the past year declined from 5.5% in 2010 to 3.6% in
2015.
Cancer Screening
Early
detection of cancer through screening reduces mortality from cancers
of the breast, uterine cervix, colon, rectum, and lung. In addition,
screening for colorectal and cervical cancers can prevent these
cancers by identifying and removing precancerous lesions.
In 1987,
less than one-third (29%) of women 40 years and older reported having
a mammogram within the past two years. That number rose to 70%
by 2000, but in 2015 had dropped to 64%. Mammography use in the past
two years was lowest among the uninsured (31%). An estimated 55% of
women 45 years and older with less than a high school degree reported
having a mammogram within the past two years compared to about 78% of
college graduates.
Among
women ages 21 to 65, 83% were up-to-date with cervical cancer
screening in 2015. Only about 72% of women with less than a high
school education were up-to-date with cervical cancer screening
compared to about 91% of college graduates. Uptake was lowest among
the uninsured (64%) and recent immigrants (70%).
In 2015,
63% of adults ages 50 years and older were up-to date for
colorectal cancer screening. Prevalence was less than or equal to
50% among Hispanics, Asians, people with less than a high school
diploma, recent immigrants, and the uninsured.
In 2015,
only 4% of eligible former and current smokers reported having a
low-dose computed tomography screening for lung cancer in the
past year.
The ACS
press release quotes the ACS review article authors “With a few
exceptions, men and women with lower educational attainment reported
both a higher prevalence of modifiable cancer risk factors and lower
utilization of potentially life-saving cancer screenings.” Patterns of
cancer risk factors and screening by race/ethnicity are more complex
and reflect cultural factors that influence behaviors.
According to Goding Sauer and colleagues, “Reducing these modifiable
cancer risk factors and improving cancer screening will require broad
implementation of national, state, and local policies,
social/community efforts, as well as individual behavioral
interventions.” And “Such systematic efforts should be enhanced across
all populations, particularly those most at risk, including those with
lower [socioeconomic status] and racial/ethnic minorities.”
To access the full
report, visit:
https://bit.ly/2IyPtd9
To access the journal
article,
Current Prevalence of Major Cancer Risk Factors and
Screening Test Use in the United States: Disparities by Education and
Race/Ethnicity. Ann Goding Sauer, Rebecca L. Siegel, Ahmedin Jemal,
and Stacey A. Fedewa. Cancer Epidemiol Biomarkers Prev April 3 2019
DOI: 10.1158/1055-9965.EPI-18-1169
■
|